Awards of Courage

Kenneth H. Mayer, M.D.

Honoring with Pride 2002 Honoree

Kenneth H. Mayer, M.D., is Professor of Medicine and Community Health at Brown University, Director of the Brown University AIDS Program, and an attending physician in the Infectious Disease Division of the Miriam Hospital in Providence, Rhode Island. In addition, he is Adjunct Professor at Harvard University’s School of Public Health, Medical Research Director at Boston’s Fenway Community Health, and Director of Brown University’s Fogarty AIDS International Research and Training Program. As a research fellow in infectious diseases at Brigham and Women’s Hospital, Dr. Mayer was one of the first clinical researchers in Boston to see patients with HIV and AIDS.

Dr. Mayer has been the principal investigator in a federally funded study of heterosexual HIV transmission in southeastern New England. He has also been a principal investigator in studies that are part of the National Institutes of Health’s (NIH) nationwide HIV vaccine trial effort (HIVNET, HVTN), as well as in one of NIH’s HIV Prevention Trials Units that involves Fenway Community Health, Brown University, and a community-based organization in Chennai (Madras), India. In 1983, Dr. Mayer co-authored The AIDS Fact Book, one of the first books about AIDS written for the general public. He also co-edited The Emergence of AIDS: Impact on Immunology, Microbiology, and Public Health, published in November 2000 by the American Public Health Association Press.

Dr. Mayer has served on the Data Safety and Monitoring Board of the NIH’s AIDS Clinical Trials Group and sits on several editorial boards. He has published extensively on AIDS-related topics and is a frequent presenter at conferences and symposia worldwide. He sits on the Board of the American Foundation for AIDS Research (amfAR).

Dr. Mayer received his B.A. from the University of Pennsylvania and his M.D. from Northwestern University Medical School. He completed his residency and internship in internal medicine at Boston’s Beth Israel Hospital, while also holding clinical fellowships in medicine at Harvard Medical School and in infectious diseases at Brigham and Women’s Hospital.

Interview

How did you first get into the field of HIV/AIDS clinical research?

I’ve always been interested in the interaction between society and medicine and was active in progressive politics in the late 60s and early 70s. When I went to medical school in Chicago, I felt that being in an ivory tower environment would not be sufficient for my education, and I wanted to do something to support the gay community. There was a student group that started meeting, and there was a recognition in Chicago that gay men weren’t getting very good health care around sexually transmitted infections. So the group created a clinic, which came to be known as the Howard Brown Clinic, and I was one of the first volunteers there.

In 1980, I finished my residency in Boston and knew that I wanted to study infectious diseases. . . . I volunteered at a clinic called Fenway Community Health and eventually became a staff member. I was one of the first people in New England to see what came to be known as AIDS, and I felt from the start that not only was it important to try to help take care of people who were sick, but also that it was important to try to figure out what was going on, what was causing this. So I convinced the health center to allow me to save blood specimens and to take histories on people, and by 1984, we were one of the first sites in the country to get funding from the Centers for Disease Control to start looking at factors associated with HIV transmission among men who have sex with men. Around that same time, I went to Brown University and quickly recognized that the profile of the epidemic in Providence was different than in Boston; women were increasingly being infected by HIV. They were either injection drug users, or more frequently, partners of men who injected drugs. And the patterns of the epidemic were different among women in terms of the kinds of illnesses they had and how they manifested what came to be known as HIV disease.

As one of the first clinical researchers to see patients with HIV infection and AIDS in Boston, can you describe some of the changes that have occurred in HIV/AIDS clinical research and treatment over the years?

It’s been such a turnaround, it’s amazing. In the early days, we spent a lot of time dealing with phobic people because until we had identified an agent, we couldn’t clearly say how AIDS was transmitted. So there were all kinds of crazy people alleging that the virus is more easily transmitted [than it actually is]. We also spent a lot of time on palliative care because by the time people came in for attention they were so sick. . . . But by the mid-1990s, we had much better techniques for measuring the virus with viral load tests. We also had a much better understanding of the natural history of the disease, so we could use those tests to predict what people’s rates of progression would be. And once we had triple therapy, we really had a way to effectively slow the effects of the disease on the immune system. So HIV’s gone from being a rapidly fatal, highly morbid condition to something that is chronic. It is not without its complications, but it is a much more manageable disease. And now we’re talking to people about how they’re living their lives in terms of decades and worrying about long-term side effects and not dealing with the kinds of things we had to deal with in the beginning—like who were their family supports and who would provide palliative care.

How do you think the epidemic has changed the gay and lesbian community, either for the better or the worse?

Well, there has been a lot of good that has come of it, but it’s certainly not something you would wish on any community. I think that it has been a coming-of-age for us. One very obvious thing is the wonderful solidarity that lesbians showed in an epidemic that affected gay men. I think this made gay men realize how much they depended on their sisters. The need for solidarity really helped create more of a cohesion than ever existed before. I think the horror of the epidemic and the rapid mobilization by the community created a respect and formal presence that made it easier to advocate for political enfranchisement on every level. And I think the skills that grew out of developing community-based organizations and community-based research centers like Fenway Community Health were extremely useful when the epidemic seemed to be more under control. People sat back and said, you know we can apply these skills to other health care issues that affect our community. So that because of the AIDS epidemic, there is now increased consciousness about breast cancer screening for lesbians, increased focus on substance use in the community, and more attention to smoking cessation in the gay and lesbian community. In other words, there’s a realization that there’s more to being a gay man than HIV or HIV risk, and that the same community-based, culturally sensitive structures that are used in addressing HIV can also help address all the other health care issues.

Why do we appear to be seeing a resurgence of HIV among gay and bisexual men, and what needs to be done to strengthen prevention efforts in this community?

Boys just want to have fun. Seriously, I think in a nutshell the reason why we have an AIDS epidemic is that sex is pleasurable, and there are some people who like having multiple partners and having frequent sex, which doesn’t just change because of the awareness of a malevolent virus. But I also think there are some very specific contextual things that are going on.

In the bad old days, there were lots of people who wasted, and the frequent obituaries in gay community newspapers were constant reminders of loss and chronic morbidity. But now, when people are looking good and there is the word out on the street that the infection is manageable, it becomes a lot easier to indulge in a certain degree of denial. And I think that some people are just plain tired. It’s very hard to sustain behavior change for long periods of time—consistently, for all people. We have to think about how well large groups of people do in quitting smoking, or exercising, or dieting. Safer sex for some people is not the norm, and therefore maintaining it is not necessarily easy over the long haul. In terms of what we have to do with prevention efforts, continuing to engage people in a sex-positive but candid way is very important in saying, "It’s not over. It’s still serious, and the meds are not a day at the beach for most people."

And we need better kinds of preventive technology, such as microbicides. Most of the work I do right now in microbicides is around vaginal microbicides, but I’ve been pushing to expand that agenda to rectal microbicides. And other preventive research is crucial, including work on vaccines. It’s also important that we do research to understand the extent to which getting people on antiretroviral therapy and getting them to adhere to therapy can help reduce HIV transmission. And the last piece is that there is not just a resurgence of HIV, but a resurgence of other sexually transmitted infections, which increases people’s risk of getting infected with HIV.

Recently the international response to the global pandemic has gathered significant momentum. Where do you think our attention should be focused right now?

Sort of my third full-time job is being involved with a Brown University program called the Fogarty AIDS International Training Program. There are about 15 to 18 U.S. universities involved, and the program brings people in from Southern and Eastern Asia to get training in AIDS laboratory, clinical, or behavioral research. So I spend a lot of time both overseas and working with overseas AIDS researchers and clinicians.

If we’re talking geographically, we have to continue to focus on sub-Saharan Africa because of the preponderance of the epidemic there. But we should also focus increasingly on Southern and Eastern Asia, and certainly two countries with large populations and potential for widespread epidemics are India and China. In terms of global issues, I think we need to focus on how we can translate the radical drop in the cost of antiretroviral therapy into making medications more accessible to people worldwide. There are some very specific things that need attention, such as helping to build infrastructure so that people can get tested and find out if they’re infected; working with international funders to find ways to get the drugs into different communities; and figuring out cost-effective strategies to monitor antiretroviral therapies.

Looking to the future, what would you ask of the gay and lesbian community with regard to the fight against AIDS? Are there certain responsibilities that the community has in this battle?

I think the community has done an amazing job already in providing vision and leadership. My hope is that if we found a cure for AIDS tomorrow, people wouldn’t fold up their tents and lose sight of the fact that we’re part of a global gene pool—Marshall McLuhan’s "global village." We’re still part of that, and tomorrow’s AIDS is lurking down the road. The fact that we may not be at the epicenter of the next pandemic does not mean we should ignore it. So I hope the kind of consciousness that’s been raised—where you have activists who may have started their career in ACT UP, and then moved to Treatment Action Group, and now are working with AIDS activists in Africa and Asia to make drugs more accessible—continues. I hope that energy and enthusiasm continues as we grapple with other public health issues. We have many other major preventable killers of people out there like tuberculosis and malaria. At this point in history, it’s criminal that we’re not all thinking about how to get these epidemics under control. Having an ongoing sensitivity is crucial—because AIDS just shows us how vulnerable we have been and are going to continue to be. And I think having common cause around progressive issues is going to be necessary whether AIDS is here or not because there will be continued challenges to our civil rights.